World J Gastrointest Endosc 2015 July 10; 7(8): 830-832 ISSN 1948-5190 (online)
Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.4253/wjge.v7.i8.830
© 2015 Baishideng Publishing Group Inc. All rights reserved.
LETTERS TO THE EDITOR
Toward an easier indigocarmine chromoendoscopy Maximilien Barret, Marine Camus, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade used to help in the delineation and characterization of colorectal neoplasms. However, it usually requires the use of a spraying catheter that decreases the suction capacity of the endoscope, and is time- consuming. Herein, we report on the feasibility of indigo carmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope. Since the suction channel remains free, the air can be exsufflated and the staining then applies uniformly onto the colonic walls with the excess indigocarmine dye being imme diately eliminated. In our experience with various types of colonoscopes and cap-assisted colonoscopy, this procedure makes indigocarmine chromoendoscopy much easier and quicker to perform, and might save the use of a spray catheter.
Maximilien Barret, Marine Camus, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade, Gastroenterology Department, Cochin Hospital, 75014 Paris, France Maximilien Barret, Marine Camus, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade, Medical School, Paris Descartes University, 75006 Paris, France Author contributions: Barret M drafted the manuscript; Camus M, Leblanc S and Coriat R performed the endoscopic procedures; Prat F corrected the manuscript; Chaussade S performed the endoscopic procedures and designed the study; all authors approved the final version of the manuscript. Conflict-of-interest statement: None. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/
Key words: Indigocarmine; Chromoendoscopy; Colo noscopy; Adenoma detection rate; Colorectal cancer screening © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Correspondence to: Maximilien Barret, MD, MSc, Gastro enterology Department, Cochin Hospital, 27 Rue du Faubourg St Jacques, 75014 Paris, France. [email protected] Telephone: +33-1-58411967 Fax: +33-1-79724571
Core tip: We report on the feasibility of indigocarmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope.
Received: December 9, 2014 Peer-review started: December 9, 2014 First decision: January 8, 2015 Revised: April 13, 2015 Accepted: April 27, 2015 Article in press: April 29, 2015 Published online: July 10, 2015
Barret M, Camus M, Leblanc S, Coriat R, Prat F, Chaussade S. Toward an easier indigocarmine chromoendoscopy. World J Gastrointest Endosc 2015; 7(8): 830-832 Available from: URL: http://www.wjgnet.com/1948-5190/full/v7/i8/830.htm DOI: http://dx.doi.org/10.4253/wjge.v7.i8.830
Abstract
TO THE EDITOR
Indigocarmine chromoendoscopy has been proven to improve the detection of colonic lesions during screening colonoscopy, and is associated with increased adenoma detection rates. Furthermore, it is commonly
Indigocarmine chromoendoscopy has proven useful in increasing the overall diagnostic yield of colonoscopy [1] and the adenoma detection rate . This technique is currently recommended in routine colorectal cancer
WJGE|www.wjgnet.com
830
July 10, 2015|Volume 7|Issue 8|
Barret M et al . Indigocarmine chromoendoscopy
Figure 4 Endoscopic view of the colonic mucosa after indigocarmine staining using an Olympus® colonoscope and a cap.
Figure 1 0.2% indigocarmine solution prepared in the water bottle.
Figure 5 Endoscopic view of a sessile serrated adenoma after indigo carmine staining.
colonoscope. Spraying is performed segmentally during withdrawal of the endoscope and excess dye is suctioned before mucosal examination. However, the use of a spray catheter has a certain cost, limits the suction capacity of the endoscope and often requires several passages with the endoscope, which can sometimes be difficult in some patients. We report on the feasibility of the indigocarmine dye application directly through the colonoscope air/water channel. Upon cecal intubation, the indigo carmine solution is prepared in the water bottle, using two 10 mL vials of 1% indigocarmine diluted in 80 mL of water, in order to obtain the 0.2% concentration (Figure 1). The indigo carmine dye is delivered by pressing on the air/water valve while orienting the head of the endoscope against the colonic walls and withdrawing the colonoscope. The indigocamine dye application is shown on Figure 2. It should be noted that the indigocarmine stained water does not remain on the objective lens of the endoscope rendering clear water unnecessary for the cleaning of the tip of the endoscope during the chromoendoscopy procedure. Once the end of a colonic segment has been reached, suction of the air allows uniform application of the dye on the mucosa and elimination of excess fluid. New air insufflation is then needed for the colonic mucosal examination.
Figure 2 Indigocarmine dye application through the air/water channel of the endoscope.
Figure 3 Endoscopic view of the colonic mucosa after indigocarmine staining using a Fujifilm® colonoscope.
screening in patients with long-standing inflammatory [2] colitis or hereditary nonpolyposis colorectal cancer . The standard technique implies pancolonic spraying with 0.2% indigocarmine delivered through a spraying catheter inserted in the accessory channel of the
WJGE|www.wjgnet.com
831
July 10, 2015|Volume 7|Issue 8|
Barret M et al . Indigocarmine chromoendoscopy Immediately after the procedure, the air/water channel of the endoscope is flushed with water from another water bottle until the outflow is clear, to make sure that no indigocarmine dye remains inside the channel. After standard washing, we did not observe any residual staining in the water bottles. Our preliminary experience with 15 patients suggests that this simplified indigocarmine chromoendoscopic technique ® ® is feasible with Olympus or Fujifilm colonoscopes, with or without a cap (Figures 3-5) and with a median withdrawal time of 21 ± 12 min.
REFERENCES 1
2
Kahi CJ, Anderson JC, Waxman I, Kessler WR, Imperiale TF, Li X, Rex DK. High-definition chromocolonoscopy vs. highdefinition white light colonoscopy for average-risk colorectal cancer screening. Am J Gastroenterol 2010; 105: 1301-1307 [PMID: 20179689 DOI: 10.1038/ajg.2010.51] Kamiński MF, Hassan C, Bisschops R, Pohl J, Pellisé M, Dekker E, Ignjatovic-Wilson A, Hoffman A, Longcroft-Wheaton G, Heresbach D, Dumonceau JM, East JE. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-449 [PMID: 24639382 DOI: 10.1055/s-0034-1365348] P- Reviewer: Amornyotin S, Garcia AZG, Kikuchi H S- Editor: Gong XM L- Editor: A E- Editor: Wu HL
WJGE|www.wjgnet.com
832
July 10, 2015|Volume 7|Issue 8|
Published by Baishideng Publishing Group Inc 8226 Regency Drive, Pleasanton, CA 94588, USA Telephone: +1-925-223-8242 Fax: +1-925-223-8243 E-mail: [email protected] Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx http://www.wjgnet.com
© 2015 Baishideng Publishing Group Inc. All rights reserved.
Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.4253/wjge.v7.i8.830
© 2015 Baishideng Publishing Group Inc. All rights reserved.
LETTERS TO THE EDITOR
Toward an easier indigocarmine chromoendoscopy Maximilien Barret, Marine Camus, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade used to help in the delineation and characterization of colorectal neoplasms. However, it usually requires the use of a spraying catheter that decreases the suction capacity of the endoscope, and is time- consuming. Herein, we report on the feasibility of indigo carmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope. Since the suction channel remains free, the air can be exsufflated and the staining then applies uniformly onto the colonic walls with the excess indigocarmine dye being imme diately eliminated. In our experience with various types of colonoscopes and cap-assisted colonoscopy, this procedure makes indigocarmine chromoendoscopy much easier and quicker to perform, and might save the use of a spray catheter.
Maximilien Barret, Marine Camus, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade, Gastroenterology Department, Cochin Hospital, 75014 Paris, France Maximilien Barret, Marine Camus, Sarah Leblanc, Romain Coriat, Frédéric Prat, Stanislas Chaussade, Medical School, Paris Descartes University, 75006 Paris, France Author contributions: Barret M drafted the manuscript; Camus M, Leblanc S and Coriat R performed the endoscopic procedures; Prat F corrected the manuscript; Chaussade S performed the endoscopic procedures and designed the study; all authors approved the final version of the manuscript. Conflict-of-interest statement: None. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/
Key words: Indigocarmine; Chromoendoscopy; Colo noscopy; Adenoma detection rate; Colorectal cancer screening © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Correspondence to: Maximilien Barret, MD, MSc, Gastro enterology Department, Cochin Hospital, 27 Rue du Faubourg St Jacques, 75014 Paris, France. [email protected] Telephone: +33-1-58411967 Fax: +33-1-79724571
Core tip: We report on the feasibility of indigocarmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope.
Received: December 9, 2014 Peer-review started: December 9, 2014 First decision: January 8, 2015 Revised: April 13, 2015 Accepted: April 27, 2015 Article in press: April 29, 2015 Published online: July 10, 2015
Barret M, Camus M, Leblanc S, Coriat R, Prat F, Chaussade S. Toward an easier indigocarmine chromoendoscopy. World J Gastrointest Endosc 2015; 7(8): 830-832 Available from: URL: http://www.wjgnet.com/1948-5190/full/v7/i8/830.htm DOI: http://dx.doi.org/10.4253/wjge.v7.i8.830
Abstract
TO THE EDITOR
Indigocarmine chromoendoscopy has been proven to improve the detection of colonic lesions during screening colonoscopy, and is associated with increased adenoma detection rates. Furthermore, it is commonly
Indigocarmine chromoendoscopy has proven useful in increasing the overall diagnostic yield of colonoscopy [1] and the adenoma detection rate . This technique is currently recommended in routine colorectal cancer
WJGE|www.wjgnet.com
830
July 10, 2015|Volume 7|Issue 8|
Barret M et al . Indigocarmine chromoendoscopy
Figure 4 Endoscopic view of the colonic mucosa after indigocarmine staining using an Olympus® colonoscope and a cap.
Figure 1 0.2% indigocarmine solution prepared in the water bottle.
Figure 5 Endoscopic view of a sessile serrated adenoma after indigo carmine staining.
colonoscope. Spraying is performed segmentally during withdrawal of the endoscope and excess dye is suctioned before mucosal examination. However, the use of a spray catheter has a certain cost, limits the suction capacity of the endoscope and often requires several passages with the endoscope, which can sometimes be difficult in some patients. We report on the feasibility of the indigocarmine dye application directly through the colonoscope air/water channel. Upon cecal intubation, the indigo carmine solution is prepared in the water bottle, using two 10 mL vials of 1% indigocarmine diluted in 80 mL of water, in order to obtain the 0.2% concentration (Figure 1). The indigo carmine dye is delivered by pressing on the air/water valve while orienting the head of the endoscope against the colonic walls and withdrawing the colonoscope. The indigocamine dye application is shown on Figure 2. It should be noted that the indigocarmine stained water does not remain on the objective lens of the endoscope rendering clear water unnecessary for the cleaning of the tip of the endoscope during the chromoendoscopy procedure. Once the end of a colonic segment has been reached, suction of the air allows uniform application of the dye on the mucosa and elimination of excess fluid. New air insufflation is then needed for the colonic mucosal examination.
Figure 2 Indigocarmine dye application through the air/water channel of the endoscope.
Figure 3 Endoscopic view of the colonic mucosa after indigocarmine staining using a Fujifilm® colonoscope.
screening in patients with long-standing inflammatory [2] colitis or hereditary nonpolyposis colorectal cancer . The standard technique implies pancolonic spraying with 0.2% indigocarmine delivered through a spraying catheter inserted in the accessory channel of the
WJGE|www.wjgnet.com
831
July 10, 2015|Volume 7|Issue 8|
Barret M et al . Indigocarmine chromoendoscopy Immediately after the procedure, the air/water channel of the endoscope is flushed with water from another water bottle until the outflow is clear, to make sure that no indigocarmine dye remains inside the channel. After standard washing, we did not observe any residual staining in the water bottles. Our preliminary experience with 15 patients suggests that this simplified indigocarmine chromoendoscopic technique ® ® is feasible with Olympus or Fujifilm colonoscopes, with or without a cap (Figures 3-5) and with a median withdrawal time of 21 ± 12 min.
REFERENCES 1
2
Kahi CJ, Anderson JC, Waxman I, Kessler WR, Imperiale TF, Li X, Rex DK. High-definition chromocolonoscopy vs. highdefinition white light colonoscopy for average-risk colorectal cancer screening. Am J Gastroenterol 2010; 105: 1301-1307 [PMID: 20179689 DOI: 10.1038/ajg.2010.51] Kamiński MF, Hassan C, Bisschops R, Pohl J, Pellisé M, Dekker E, Ignjatovic-Wilson A, Hoffman A, Longcroft-Wheaton G, Heresbach D, Dumonceau JM, East JE. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-449 [PMID: 24639382 DOI: 10.1055/s-0034-1365348] P- Reviewer: Amornyotin S, Garcia AZG, Kikuchi H S- Editor: Gong XM L- Editor: A E- Editor: Wu HL
WJGE|www.wjgnet.com
832
July 10, 2015|Volume 7|Issue 8|
Published by Baishideng Publishing Group Inc 8226 Regency Drive, Pleasanton, CA 94588, USA Telephone: +1-925-223-8242 Fax: +1-925-223-8243 E-mail: [email protected] Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx http://www.wjgnet.com
© 2015 Baishideng Publishing Group Inc. All rights reserved.
